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The ICD-10-CM code to use for annual screening services is Z12.5, Encounter for screening for malignant neoplasm of prostate. Codes in the Z12 category have a “Use additional code” instruction if there is family history of the disease.
ICD 10 code for Encounter for screening for malignant neoplasm of prostate. Get free rules, notes, crosswalks, synonyms, history for ICD-10 code Z12.5.
Code Classification. Z12.5 is a billable diagnosis code used to specify a medical diagnosis of encounter for screening for malignant neoplasm of prostate. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024.
For a screening test for a patient with no signs or symptoms of disease, use diagnosis code Z12.5 Encounter for screening for malignant neoplasm of prostate. If you report another diagnosis code with G0103, Medicare will not pay for it. You must use a screening diagnosis with a screening CPT® code.
Prostate Specific Antigen. CPT: 84153. The ICD10 codes listed below are the top diagnosis codes currently utilized by ordering physicians for the limited coverage test highlighted above that are also listed as medically supportive under Medicare’s limited coverage policy.
The ICD-10 diagnosis code to support either screening is Z12.5 Encounter for screening for malignant neoplasm of prostate. There is no deductible or coinsurance/co-payment for the PSA test, but there is for the screening DRE under Medicare Part B.
Screening PSA tests are covered at a frequency of once every 12 months for men who have attained age 50 (at least 11 months have passed following the month in which the last Medicare-covered screening PSA test was performed). ICD-10 CODE. DESCRIPTION. Z12.5. Encounter for screening for malignant neoplasm of prostate.
R97.20 is a billable diagnosis code used to specify a medical diagnosis of elevated prostate specific antigen [psa]. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024.
Z12.5 is a valid billable ICD-10 diagnosis code for Encounter for screening for malignant neoplasm of prostate. It is found in the 2024 version of the ICD-10 Clinical Modification (CM) and can be used in all HIPAA-covered transactions from Oct 01, 2023 - Sep 30, 2024. POA Exempt. Z12.5 is exempt from POA reporting (Present On Admission).
There are several ICD-10 codes you might use for a diagnostic PSA test (84153). Your urologist might document conditions such as malignant neoplasm of prostate (C61), gross hematuria (R31.0), or elevated PSA (R97.2).